Pick Your Future Health Care Adventure

Does all the health reform chatter have you ready to jump into a high risk pool or bend a cost curve of your own? Take a deep breath and try to look past it all: It’s the future, 2025 to be specific, and your name is Mary.

That’s right, you’re a 50-year-old, middle-income, single woman with diabetes. And your health has been impacted in dramatic ways by forces beyond your control.

How? Well, in a new report, the aptly named Institute for Alternative Futures lays out four scenarios that could become realities for primary care by 2025. And for you, Mary, that means the potential for four very different — but equally plausible — futures.

The various health policy decisions, technological advances and political outcomes that remain to be seen will determine the fate of your health care — and health. Here, with the help of the officials behind the report, we launch you into four parallel health care worlds.

Behold, Mary. These are your lives.

SCENARIO 1: “Expectable Future“

In this scenario, which is a continuation of current trends, policymakers have ramped up access to preventive care, in part through a concept called the “patient-centered medical home.” Back in 2014, the Affordable Care Act expanded coverage to most Americans, emphasized coordinated care and greatly boosted the use of electronic medical records. People like Mary have a primary care team that includes a physician, a nurse practitioner (who is actually her main point of contact), social workers and others who take care of the vast majority of her needs. They heavily reference her electronic medical record, which tracks her life history, her lifestyle and all bio-monitoring data that comes from devices she wears on her body — earrings, a wristwatch, and a sleep pad that gives a pretty comprehensive picture of her health. Mary also has access to a digital health coach — a virtual personality that helps condense all the medical information available online to advise her on behavior changes that she might want to consider.

SCENARIO 2: “Challenging Future“

To put it mildly, things don’t look so bright in this second outcome. With greater economic difficulties prompting significant cuts in federal health care spending, many doctors grew fed-up with lowered reimbursement rates and retired early. That led to even greater health care shortages and decreased access for many Americans, including Mary. Most blame the hardships on the passage of the Affordable Care Act, which caused many employers to stop providing health insurance. Mary considers herself lucky to still have a low-paying job in the aftermath of the second Great Recession, but she can’t really afford any kind of real health insurance on her own. So she relies on the minute clinics, online information and emergency rooms when necessary. But her diabetes is so out-of-control she may lose her eyesight or need a limb amputation.

SCENARIO 3: “Aspiring Future“

In this scenario, most health care initiatives embrace a triple aim promoted as the key implementation goal of the ACA — enhancing the patients’ experience, reducing per capita health care costs, and improving the overall health of the population. The latter means the “patient-centered medical home” has become a “community-centered health home” that monitors and contributes to the overall health of the general population. Mary works with Eva, a community health worker, to manage her diet and exercise. She has a health team: a doctor, nurse and access to all the health professionals. But Eva’s her primary contact and the one who works with her on a daily basis — the one who visits her three or four times per year and reviews Mary’s health data so that she doesn’t run the risk of diabetes-related conditions. To top it off, Mary has joined a group of other diabetics who like to walk together in the early evening, and for much of the year she gardens daily in one of the two community gardens started by her community health center.

SCENARIO 4: “Surprisingly Successful Future”

In our fourth scenario, primary care is divided into two major camps. The bulk of the health care system has been transformed into personalized programs supported by technologies that allow people to take over many functions of primary care for themselves. A second branch provides efficient, cost-competitive care for complex health needs — services that are only necessary when people still need care despite all the new, preventive programs. Mary takes care of herself quite well. Her job doesn’t cover her health insurance, but she has a consumer-directed plan through her state’s Health Insurance Exchange that gives her what she needs. That includes a very effective digital health coach, which analyzes her personal bio-monitoring and genetic code and recommends steps she should take to improve her health. When she does need a doctor, the digital coach analyzes the quality and the price of the doctors in her neighborhood, relates those to the recommendations of her friends, and tells her the best option based upon her budget and health needs.

So, Mary, which do you prefer, and which do you think is most likely? Participate in the poll below — which will remain open until Feb. 7 — and share your thoughts in the comments section. Check back next week for the results, as well as expert analysis on the likelihood of the four scenarios and a look at what will need to happen for each to become reality.

Which Scenario Do You Think Is Most Likely? Click each scenario to rate its likelihood.

The scenarios were developed in consultation with some of the top health care experts in the country, and with the support of The Kresge Foundation, which is also a NewsHour underwriter. Read the full report here.